Eczema & Dermatitis & MM

Question 1

What is dermatitis?

Answer 1

inflammation of the skin

Question 2

How does dermatitis appear?

Answer 2

sore, red, itching skin

Question 3

What are the two most common types of dermatitis?

Answer 3

Irritant dermatitis - irritant penetrates the outer layer of the skin to invoke a physiological response
Allergic dermatitis - requires sensitisation, once sensitised to an allergen, re-exposure triggers memory T cells to initiate an inflammatory response 24-48 hours after re-exposure

Question 4

What are symptoms of dermatitis?

Answer 4

• Dry, flaky skin that may be inflamed and have small red spots
• Skin may be broken and weepy and sometimes thickened
• Affected skin may be irritating and extremely itchy

Question 5

Where are the common affected sites?

Answer 5

• Most commonly affected sites include the nappy area, neck, back of the scalp, face, limb creases, flexures (behind knees and elbows) + back of the wrists

Question 6

When to refer a pt with dermatitis?

Answer 6

• signs of infection (weeping, crusts, rash spreading)
• severe symptoms e.g. cracked skin, bleeding
• symptoms unresponsive to tx
• no identified cause, not previously diagnosed as eczema
• symptoms lasting longer than 2 weeks

Question 7

What tx options can be recommended for pts with dermatitis?

Answer 7

1. Topical corticosteriods e.g. hydrocortisone, clobetasone suitable for mild-moderate eczema that is not broken and should not be sold for use in children (under 10 years for hydrocortisone, under 12 years for
   clobetasone) for maximum 7 days used
   max of 15g can be sold at any one time
   cant be used on facial skin, the anogenital region or broken or infected skin
2. Emollients - mainstay of tx for soothing skin, preventing drying and for using as a soap substitute or as bath additives

Question 8

Name some common OTC preps.

Answer 8

Oilatum
Aq cream
emulsifying ointment
Epaderm 
Cetraben 
Doublebase

Question 9

if the skin is dry to very dry, what tx is best?

Answer 9

ointment

Question 10

if the skin is mildly dry, what tx is best?

Answer 10

cream

Question 11

if the skin is broken or weeping, which is best?

Answer 11

water-soluble cream

Question 12

How much steroid should be applied ?

Answer 12

finger tip unit - tip of the finer down to the first crease

Question 13

The quantity required for both hands? both arms? Both legs or trunk?

Answer 13

both hands - 15-30g
both arms 30-60g
both legs or trunk 100g

Question 14

how long after used the steroid can the emollient be applied ?

Answer 14

30 minutes after

Question 15

on exposure to ultraviolet light, what do our melanocytes do?

Answer 15

increase production of melanin which absorbs both UVA and UVB protecting skin from damage

Question 16

what is sunburn?

Answer 16

inflammatory response to excessive exposure to ultraviolet light whereby an increase in inflammatory mediators results in capillary vasodilatation and increased capillary permeability

Question 17

What occurs to the skin when there is melanin production?

Answer 17

epidermal hyperplasia occurs, causing skin to thicken and this provides further protection against the skin

Question 18

Where is the most common sites of melignant melanoma (MM)?

Answer 18

• in women lower leg

- in men back of the neck

Question 19

what are risk factors of MM?

Answer 19

multiple moles
those with susceptible sunburn skin types
early childhood exposure to sun

Question 20

What is the 7 point rule?

Answer 20

Major (scores 2):
change in shape
change in size
change in colour

Minor (scores 1): 
largest diameter 7mm or more 
inflammation
oozing 
change in sensation (itch or irritation) 

any lesion should be suspected with a score of 3 or more

Question 21

What is the ABCDE rule ?

Answer 21

A - Asymmetry - irregular in shape
B - Border - irregular border with jagged lines
C - Colour - shades of brown mixed with black, red, pink, white or blush tint
D - Diameter - more than 7mm in diameter
E - Evolution - all of the above has changed with time

Question 22

When to refer?

Answer 22

facial lesions especially in those over 60
lesions that have become itchy, irritated or are prone to bleeding
Moles changed in shape etc

Question 23

What acronym is used for avoidance measures?

Answer 23

SMART

SLIP!SLOP!SLAP!SEEK!SLIDE!

Question 24

What does the acronym SMART stand for?

Answer 24

S - spend time in the shade between 11am to 3pm
M - Make sure you never burn
A - aim to cover up with a t-shirt hat and sunglasses
R - Remember extra care with children
T - Then use factor 15+ sunscreen and four stars

Question 25

What medicines cause medicine-induced photosensitivity?

Answer 25

1. NSAIDS
2. Tetracyclines
3. chlorpromazine
4. Phenothiazines
5. amiodarone
   cause pruritus and skin rash when the skin is exposure to natural sunlight